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Insurance Status Versus Hospitalized Patient Outcomes with Pulmonary Hypertension: National Hospital Discharge Survey, 2000-2010

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Conference: 2015 PH Professional Network Symposium

Release Date: 09.15.2015

Presentation Type: Abstracts

File Download: 2015 Symposium Abstract - 1001b

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Purpose

To determine if patients’ insurance status is associated with higher mortality in those that are hospitalized with pulmonary hypertension.

Background

Pulmonary hypertension, which is listed on hospital records as either primary pulmonary hypertension or pulmonary hypertension secondary to another underlying condition or disease, is a rare disease associated with mortality and considerable healthcare costs in the U.S. population. Additionally, in many fields of medicine, insurance status has been demonstrated to be directly correlated with disparities in utilization of medical care, treatment of disease and outcome of treatment. Such insurance-related disparities have not been studied in relation to pulmonary hypertension.

Methods

Data was taken from the 2000-2010 National Hospital Discharge Survey (NHDS), which is a population-based survey conducted by the National Center for Health Statistics. This survey includes information on discharges from a sample of non-federal, short-stay hospitals. All individuals from this nationally representative study were 20 years and older and had pulmonary hypertension. Patients who either had been uninsured or had Medicaid were compared to patients covered under a variety of commercial insurers, as well as Medicare exclusively. A pulmonary hypertension (PH)-related hospitalization was defined as any patient with an ICD-9-CM diagnosis of pulmonary hypertension during admission. Death during hospitalization was regarded as a negative discharge outcome. Due to the complex sampling design, sample weights were utilized in order to analyze the data. Comparisons were analyzed using Pearson’s Chi Square, simple, and multivariable logistic regression to determine the relationship of health coverage and discharge status. All missing variables were excluded.

Results

Data was available for 20,504 PH-related hospitalizations (63% females vs. 37% males) which was representative of 240,401 individuals and a mean age of 69.6 (S.E. 0.20). In this subgroup, the prevalence of PH-related deaths was 3.8% in Whites, 2.2% in Blacks/African-Americans, and 0.3% in American Indians/Alaskan Natives. Among PH-hospitalizations, the proprietary hospitals had lower levels of PH-related deaths (2.0%) than government (3.4%) and non-profit hospitals (3.7%). The overall unadjusted odds ratio for death among Medicaid coverage to other health coverage was 2.31 (95% confidence interval [CI], 1.36-3.91, p < 0.05). The adjusted OR was elevated, 1.31 (CI 0.77-2.25, p > 0.05), after controlling for demographic (race, gender, age, days of care, and marital status) risk factors.

Conclusion

Individuals who are uninsured or have only Medicaid coverage may have a 131% higher chance of mortality than those who have private coverage or other insurances, among those with PH. Consequently, more effort needs to be placed in addressing insurance-related disparities associated with PH so that they can avoid negative discharge outcomes. Healthcare professionals need to ensure that individuals with Medicaid also are diagnosed and treated on time so that this can delay the associated complications, and these individuals can suffer less morbidity and mortality. More longitudinal studies need to be done to understand the precise connection of insurance status and pulmonary hypertension.